Implementation of India’s national health insurance scheme: experience from the field
Rashtriya Swasthya Bima Yojna (RSBY) is a health insurance scheme, implemented by the Ministry of Labour and Employment, Government of India. The objective of this scheme is to provide protection to families below poverty line (BPL), against illnesses which involve hospitalisation. Currently, it covers beneficiaries’ families up to Rs 30,000 for most of the diseases that require hospitalization. In a BPL family, up to five members are eligible to get enrolled in the scheme and the government pays the premium of this policy to the insurance company. Each enrolled member of the scheme gets a biometric enabled smart card (SC), in which the basic personal details, photographs and thumb impression are stored. Beneficiaries need to present this smart card at the empanelled hospital to avail cashless treatment. As per the guidelines of the scheme, the smart card is issued at the time of enrolment itself, so that the beneficiary can start availing the benefit of the scheme immediately after the enrolment.
RSBY has been implemented in the state of Karnataka from 2009 and as per the official estimates, about 59% of BPL families have been enrolled in the scheme. I got an opportunity to witness an RSBY enrollment camp and in this blog, I would like to share my experience of interacting with the personnel involved in the camp. Once the camp started, the computer operator started taking photos and thumb impressions of the beneficiaries, but I noticed he was not providing the SC and Empaneled Hospital List (EHL) to them. Upon enquiring with the computer operator and his higher authority as to why the beneficiaries were not being given the SC and EHL, I instantly received a response that there was some technical issue. I pursued the matter further, to which the computer operator replied that the EHL was out of stock and that “if the cards were printed and provided at the time of enrolment they will not able to enrol more people thus not being able to reach the day’s target’’. He went on and clarified that due to this, they enroll the eligible people first, and will distribute the printed card along with list of hospital empanelled under the scheme after 10 days to beneficiaries through ASHA. His answer did not convince me completely, but I had no option other than to wait and see if the beneficiaries received their cards.
After a month of enrollment, I checked with few ASHAs if the SCs have arrived, to which they replied that neither had they received any cards nor any documents. The whole incident surprised me! I continued to keep in touch with the ASHAs and enquire if they had received any of the cards. After three months, I found out that the cards were given to the ASHAs but they were less in number when compared to the enrolled beneficiaries. As per the list, the number of beneficiaries enrolled were 648 but only 500 cards were provided. Later, when I asked the ASHAs if they had distributed the cards, they said that they had not. They went on to tell me that as per the contract between ASHAs and Third Party Administrator , the ASHAs should get an incentive of Rs.7 per card; since they did not receive this incentive from the agency, they kept the cards with them instead of distributing them to the beneficiaries.
This is not an isolated episode. Studies have shown issues with enrollment and card disbursement as major factors affecting the utilization of the scheme. Poor awareness of the scheme in the community is another major issue, which needs to be addressed. All these experiences show that monitoring activities of the scheme needs to be strengthened. The enrolment camps are great platforms for creating awareness about the scheme. Sound IEC activities along with good governance of the scheme will go a long way in improving access to healthcare for the poor.
Santosh M Sogal is Research Officer at Institute of Public Health, Bengaluru, shares his experiences and views on RSBY, the national insurance scheme of India.
Disclaimer: IPH blogs provide a platform for staffs to share their reflections on different public health topics. The views expressed here are solely those of the authors and not necessarily represent the views of IPH.
